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1255675146
NICOLE R. FORMWALT
MOBILE, AL
NPI
1255675146
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: AL 2227)
Enumeration Date
2012-11-16
Last Update Date
2012-11-16
Business Address
-- NICOLE R. FORMWALT LPC
7305 COTTAGE HILL RD
MOBILE, AL 36695-2829
Phone number: 251-422-2043
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Mailing Address
-- NICOLE R. FORMWALT LPC
54 GLENWOOD ST
MOBILE, AL 36606-1905
Phone number: 251-476-7148
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